Monday, August 29, 2005

A Visit From the Jaycos

A Visit From the Jaycos - I haven't been able to post for a few weeks because of our impending JCAHO survey. Now that it is over (and we are still fully accredited), I will be able to get back to "real life" and blogging. I do have to say that we had an intense, but very positive survey experience. The surveyors were thorough, fair, and tried to provide as much education as possible to the leadership and our staff. This was our first experience with the tracer methodology and everyone noted that it was an improvement over the older survey methodology.

So will JCAHO help us get to the healthcare system of the future? I think it certainly has a role and its new Shared Visions, New Pathways seems to be a positive shift in accreditation philosophy.

The cost of accreditation has always been an issue, especially when it is compared with the value of the survey process, or stated differently, the value created for the patient by an organization being accredited. JCAHO has taken a swing at both of these issues with its new philosophy.

On the cost side, the process of preparing for a survey in man-hours (and copying!) was always considered much higher than the actual charge for the Joint to come out and do the survey (a number of thousands of dollars based on the size of the organization). By making its surveys unannounced and emphasizing the importance of continual readiness, healthcare organizations are forced to build compliance with the standards into their systems. Building a system right is much less costly and more effective than trying to fix it in a hurry.

On the value side, I have heard the criticism that, at worst, JCAHO's focus on policy and procedure distracts form patient care and, at best, that JCAHO sets the bare minimum standard for "quality" care. The tracer methodology has certainly taken the focus from policies to patient care (though we still had to provide a number of binders!). When the surveyor starts thumbing through a chart, you become keenly aware that every chart, and thus every patient, needs to have all the bases covered - informed consent, pain assessment, plan of care, etc. While many of the standards focus on the very mundane topic of documentation, it does provide value to the patient for all the documentation bases to be covered. Further, JCAHO has made patient safety a key aspect of the accreditation process with its National Patient Safety Goals. You can't argue that the NPSG have not improved care.

So, with this new survey process, JCAHO is raising the bar for healthcare quality - it has at least helped us to raise the bar. As JCAHO evolves, so do the thousands of healthcare organizations that it accredits, so here is to JCAHO and its new vision. Cheers!

Tuesday, August 09, 2005

What is Right

What is Right - With all the media attention on what is wrong with healthcare, I thought I would try to list a few things that are right with healthcare. If we are diligent, we can build on these trends and create a better healthcare system for tomorrow.

IHI's 1ooK lives campaign
is right on the mark. They have taken solid patient safety research and set out on a self-styled "political campaign" to sign hospitals up to help meet their goal of saving 100,000 lives. Participating hospitals implement the best practices, collect and send in the data, and wait for the final count in June 2006. Assuming the target is reached, this is going to be a big win for the industry. I think this will generate a lot of momentum around patient safety and set the stage for future campaigns.

Palliative care is the right way to care for people in the last stages of life. While I haven't seen a lot of momentum around palliative care, it is certainly a concept of care that has matured and found increasing acceptance and adoption within hospitals. Palliative care recognizes that patients have different needs and goals in the last stages of life and customizes care to meet those needs. One organization that is leading the way to build palliative care programs is the Center to Advance Palliative Care.

Research in the design of healthcare facilities is creating environments that truly promote healing and wellness. Evidence-based design, as it has come to be known, creates environments for patients that reduce noise, decrease the risk for the spread of infection, and promote wellness through improved space for families and exposure to nature and natural light. The research has shown that well designed facilities reduce length of stay, increase staff satisfaction and morale, and are less expensive to operate. The Center for Health Design has pioneered the concept of evidence-based design and is a great resource for any hospital that is considering major capital investment in facilities.

Wednesday, August 03, 2005

Saving Healthcare

Saving Healthcare - I believe that Health Savings Accounts (HSAs) will have a significant and positive impact on how healthcare is purchased and utilized. Detractors say that HSAs don't work for everyone - and that may be true - but HSAs have major advantages that will thrust them into a prominent role in our industry.

First, employers will realize that HSAs will save them a significant amount of money on health expenditures. HSAs are basically a shift from a defined benefit to a defined contribution - this transition has already taken place with retirement benefits. This will not take employers completely out of the healthcare purchasing business, but it will significantly change the employers role in healthcare utilization decisions - an area that has always been awkward for employers. The end-user of healthcare services (the employee/patient) , will finally be the one making the healthcare purchasing decisions.

This is the second main advantage of HSAs: the patient becomes the purchaser. Little argument needs to be made why this is a benefit, though some have questioned whether or not the patient has the capacity to be a good purchaser of healthcare services. This, I imagine, will be a self-correcting problem. There are innumerable resources available for consumers to make smart purchasing decisions - websites, consumer guides, entire networks on television; once patients become purchasers in any significant number, the same type of resources will materialize and enable better decision making.

In light of this coming trend, this question must be answered: what is the provider community going to do with consumer driven healthcare? Indeed, the insurance industry is already offering HSAs and other consumer-driven products. The simple answer, in broad terms, is that providers will need to revisit not only how they market their products to potential patients, but the very structure of how they provide care. A timely article from HealthLeaders entitled Hospitals and Consumer-Driven Healthcare: Five Marketing Moves offers a number of excellent suggestions for hospitals on the marketing front. On the structure side of the question, providers need to ask what the "consumer-driven patient" is truly looking for - one-stop shopping, integrated services, common sense billing, a comprehensive approach to their health.

The hope behind consumer-driven healthcare and HSAs is that the patient will be able to purchase care that meets their health needs better. It is time for healthcare providers to offer that kind of care.